Despite the advent of antiretroviral therapy (ART), the human immunodeficiency virus (HIV) epidemic remains a global health crisis with a high burden of respiratory disease among infected persons. While the early complications of the epidemic were dominated by opportunistic infections, improved survival has led to the emergence of non-infectious conditions that are associated with chronic respiratory symptoms and pulmonary disability. Obstructive ventilatory defects and reduced diffusing capacity are common findings in adults, and the association between HIV and chronic obstructive pulmonary disease is increasingly recognized. There is synergism between viral factors, opportunistic infections, conventional influences like tobacco smoke and biomass fuel exposure, and potentially, the immunological effects of ART on the development of HIV-associated chronic obstructive lung disease. Pulmonary function data for HIV-infected infants and children are scarce, but shows that bronchiectasis and obliterative bronchiolitis with severe airflow limitation are major problems, particularly in the developing world. However, studies from these regions are sorely lacking. There is thus a major unmet need to understand the influences of chronic HIV infection on the lung in both adults and children, and to devise strategies to manage and prevent these diseases in HIV-infected individuals. It is important for clinicians working with HIV-infected individuals to have an appreciation of their effects on measurements of lung function.
This review therefore summarizes the lung function abnormalities described in HIV-positive adults and children, with an emphasis on obstructive lung disease, and examines potential pathogenic links between HIV and the development of chronic pulmonary disability.
A case report illustrating this review is available inRespirology Case Reports:http://dx.doi.org/10.1002/rcr2.71.
Calligaro GL, Esmail A, Gray DM. Severe airflow obstruction in vertically acquired HIV infection. Respirology Case Reports 2014; doi: 10.1002/rcr2.71.
Human immunodeficiency virus (HIV) infection is increasingly recognized as a risk factor for chronic airflow limitation and pulmonary disability in both adults and children. Viral factors, immunological effects and the consequences of repeated opportunistic infections (including tuberculosis) are all implicated mechanisms. To illustrate the complexity of these interactions, we present the case of a 15-year-old girl with vertically acquired HIV infection, multiple episodes of pulmonary infection and a severe obstructive ventilatory impairment.
Main teaching points:
In developing countries, chronic airflow limitation in vertically infected HIV-positive children who survive infancy is an important cause of pulmonary disability.
The causes of this disease are multifactorial: obliterative bronchiolitis and bronchiectasis, increased susceptibility to inhaled noxious particles, immune reconstitution and chronic inflammation all play a role.
Delayed access to antiretroviral therapy (ART) and uncontrolled HIV viral replication are also associated with accelerated lung function decline.
There is a paucity of data on the pharmacological management of HIV-associated airflow obstruction in both adults and children; however, early and widespread access to ART, childhood immunization against common respiratory pathogens, antibiotic prophylaxis and prompt treatment of opportunistic infections are important preventative strategies.